The only thing I could publicize well would be my tooth
Which I could say came with my mouth and in a most engaging manner
With my whole self, my body and including my mind,
Spirits, emotions, spiritual essences, emotional substances, poetry, dreams, and lords
Of my life, everything, all embraceleted with my tooth. . .
--from Thank You by Kenneth Koch
I wrote a song about dental floss but did anyone's teeth get cleaner?
---Frank Zappa
On March 3, 2010, Irwin D. Mandel, DDS was the first recipient of the American Association for Dental Research's Distinguished Mentoring Award which was "established to provide national recognition for outstanding efforts to foster and promote research training and career development of students, trainees and junior faculty" to an individual with "an exemplary record of mentoring".
On October 23, 2009, the New York State Dental Foundation bestowed a 2009 Foundations of Excellence Award in Research on Irwin Mandel, DDS, Oral Biologist "in recognition for commitment to applying creative, science-based methods to foster greater understanding of and to improve overall oral health".
Dr. Ira B. Lamster, Dean, Columbia University College of Dental Medicine, introduced him (thanks for his permission to post): "Irwin Mandel is a graduate of CCNY and the College of Dental Medicine (then known as the School of Dental and Oral Surgery), Class of 1945. He joined the faculty at Columbia as a Research Assistant in 1946, and then devoted more and more time to his research interests and his academic career, rising up the academic ladder to become a Professor of Dentistry in 1967. He held a number of important positions at the College, including [founding] Director of the Center for Clinical Research in Dentistry, Associate Dean for Research, and then in 1992 he was appointed as Professor Emeritus. His relationship continues with Columbia, and Irwin has been part of the University for nearly 70 years.
We honor Irwin today for his research activities and his commitment to preventive dentistry. His research contributions are legendary, and his work changed the way we think about common oral diseases. Irwin introduced us to the biochemistry of the oral cavity, and his efforts helped define the nature of the host response in dental caries. In essence, Irwin is an ecologist, as he helped us understand the complexity of the oral environment.
Irwin can be characterized as prescient. Today there is a great deal of interest about saliva as a diagnostic fluid for oral and other diseases. Irwin saw these possibilities, wrote about them, and made us think about them some 35 years ago. His work on preventive dentistry was transformative. He guided us towards a realization that we needed to move from the strictly surgical model to the medical model, and that prevention is the foundation of oral health care.
Irwin is also acknowledged as an inspirational teacher and mentor. In fact, in 2004 his former students gathered at the College for a symposium in his honor. This was one of the University-recognized events associated with the University’s 250 anniversary. Irwin was also honored during that celebratory year as one of 50 “Great Columbians.”
As you would expect, Irwin has been honored for his work in a variety of ways. He has received honorary doctoral degrees from the University of Medicine and Dentistry of New Jersey (1981), University of Göteberg in Sweden (1994), and Columbia University (1996). In 1985 Irwin received the first ADA Gold Medal Award for Excellence in Dental Research. He has received many other acknowledgments, but let me also mention that he was the recipient of the Jarvie-Burkhardt Award given by the New York State Dental Association in 1990.
. . .A true measure of Irwin’s impact is that he continues to receive these important awards more than 15 years after he retired from Columbia. Today we continue to study his work, reflect on his foresight, and admire his accomplishments."
On September 10, 2004 a Symposium on Irwin D. Mandel: His Legacy in Oral Health Care organized by the School of Dental and Oral Surgery was held as part of the 250th Anniversary of Columbia University. "This symposium [honored] Professor Emeritus Irwin Mandel, D.D.S., '45, world renowned researcher and academician. The symposium [featured] presentations by Irwin's former students who have achieved national prominence in the dental profession." In honor of the school’s 75th anniversary, he researched and wrote a history of the school, which was supplemented for the 90th anniversary with a biographical epilogue about his professional work and legacy.
On October 20, 2007, Dr. Irwin D. Mandel ’45, Professor Emeritus In Dentistry, was awarded the Lifetime Achievement Award at what’s now called the College of Dental Medicine’s 90th Anniversary Gala:
"Dr. Irwin Mandel received his DDS from the School of Dental and Oral Surgery in 1945. He began his tenure at Columbia as a research assistant, and practiced part-time for twenty years before devoting himself full-time to research and teaching. In 1971 he served as director of the Division of Preventive Dentistry, the first such department in the country. He founded (in 1984) and directed the Center for Clinical Research in Dentistry, serving as a mentor to many junior faculty members and dental students in his research laboratory. He served as the School’s Associate Dean for Research before being appointed as Professor Emeritus in 1992. Dr. Mandel authored over 250 scientific publications. His research interests encompassed a number of areas including caries, periodontal disease, preventive dentistry, salivary chemistry and diagnostics, and the relations of saliva to oral and systemic disease. A past president of the American Association for Dental Research, Dr. Mandel received numerous prestigious awards including the first Gold Medal Award for Excellence in Dental Research from the American Dental Association in 1985. He holds honorary degrees from the University of Medicine and Dentistry of New Jersey (1981) and the University of Goteborg, Sweden (1994) and received the honorary degree of Doctor of Science from Columbia University in 1996.”
The citation was included in an exhibition at Low Library:
Here’s his response to the award:
”Thank you for this wonderful honor and the very generous comments, and a special thanks for the fond memories they evoke. The Medical Center and the close proximity of the Medical and Dental Schools provided an ideal environment for joint research. The Faculty Dining Room was a common ground for getting to know each other and discover mutual interests. The relatively small size of the Dental School and modest space available for laboratories provided an intimacy that larger institutions often lack. At the Medical Center, togetherness was virtually thrust upon us. I recently counted the number of co- investigators from the Dental and Medical Faculties with whom I had the good fortune to work--it was over 40.
We have been fortunate at the Dental School to have had, virtually since its inception, an atmosphere supportive of student research, and a group of role models among the Faculty who made themselves and their laboratories available. Some of you may remember Drs. Ziskin, Zegarelli, Kutcher, Karshan, Tanenbaum, Lazlo Schwartz, and others will come to mind. Students spent summers and often after hours during the school year, just as they do today. In our lab over the years we had more than 30 student researchers from Columbia classes, as well as a number of foreign students, college and high school students. Quite a few are prominent researchers at various institutions around the country -- Larry Tabak, Martin Taubman, Phil Fox, to name a few.
It’s been an exciting time for me. For nearly 50 years, the Dental School has been a second home to me. Fortunately, I didn’t have a sub-prime mortgage. I did have a prime family -- my lovely wife Charlotte [center sitting, a poet] always supportive, and my children, Richard [the Celticbanjo-playing/guitarist], Nora [left, standing] and Carol [the library dean], tolerated my homework occupying most evenings. Thank you all for your warm welcome.”
Consumer Reports on Health congratulated him in the February 2008 issue as A Dental Hero by Editor Ronni Sandroff: “Controversial dental decisions are the subject of this month’s Special Report. . . This and many of our other Dental Reports owe much to the guidance of Irwin D. Mandel, DDS, who wrote his first article for Consumer Reports Magazine in 1949 and has been this newsletter’s chief dental adviser since it was launched in 1989. Readers may recall some of Dr. Mandel’s 14 “Office Visit” columns, which covered everything from overcoming dental fears to dry mouth, bad breath, fluoride and how to select a good toothbrush.
What you may not know is that Dr. Mandel is affectionately known as the “General of the Salivation Army” by his colleagues at the Columbia University of New York, where he was recently honored with a lifetime achievement award. He was cited for his groundbreaking research in saliva chemistry. His research on dental plaque is credited with having a major role in shifting the emphasis of dentistry from repair to prevention. A longtime social activist and a tireless voice on behalf of the consumer and dental product testing, Dr. Mandel is also the preventive dentistry consultant to NASA’s manned mission to Mars project.
On behalf of the whole staff, it is my pleasure to salute Dr. Mandel on his latest award and many other accomplishments, and thank him for being such a good friend of this newsletter over the years.”
He is also considered “the father” of the Student Research Group of the American Association for Dental Research, and a Student Research Fund at Columbia was named in his honor.
Contributions to The Irwin D. Mandel Research Fund can be sent to:
Development Office
Columbia University College of Dental Medicine
630 West 168th Street
New York, NY 10032
As a mentor, he has inspired:
“This volume is dedicated to Irwin Mandel, Professor Emeritus of Dentistry at Columbia University. Without question, he is the father of the field of salivary research. We recognize him as the major general of the “Salivation Army,’ and a mighty good general too. His dedication, his discoveries, and the large group of his students and colleagues that have been influenced by his teachings are immense. The field of salivary research and oral-based diagnostics highlighted in this meeting and in this volume of the Annals of the New York Academy of Sciences are dominated by his ideas. As his students, colleagues and friends, we thank you, Irwin, for your continued enthusiasm and commitment to the development of salivary diagnostics. We salute your role in creating this field, and cherish your support and friendship.”
-------------Daniel Malamud, NYU College of Dentistry, NY, NY, from: Oral-Based Diagnostics, Volume 1098, 2007.
Here's a PDF of his more personal perspective -- On Being a Scientist in a Rapidly Changing World, from Journal of Dental Research, February 1996; 75: 841 – 844, originally presented at the symposium, Toward Responsible Research Conduct: The Role of Scientific Societies, on March 10, 1995, at the Annual Meeting of the American Association for Dental Research in San Antonio, Texas.
In the mid-1940s at Columbia University School of Dental and Oral Surgery, Dr Irwin Mandel began a pioneering career in research on salivary chemistry in health and disease. It brought him an international reputation, an array of awards, and honorary degrees from prestigious universities. In the first half of his 50-year tenure at Columbia, he shared his commitment to research with the operation of a half-time private practice in Manhattan. Then, after giving up his practice, he became a full-time faculty member at Columbia as division head of preventive dentistry and community health, and concluded his service as associate dean for research. Dr Mandel has become recognized by his peers at Columbia and by the academic community across the United States as a symbol of integrity, both in his research and as a person. Shaped in childhood by a culture of caring in a community of Jewish immigrants to which his father was dedicated, he became well-known for his thoughtful mentoring of rising scientists. Additionally, for much of his life, he was a committed social activist.
Do You Really Need A Turbo Toothbrush? Bathroom Wars Escalate With Gillette's New $6 Model; Pulsating After Every Meal by Charles Forelle, The Wall Street Journal, 10/1/2002 Page D1 (fair usage excerpts)
. . .There’s a brush war flaring in your bathroom.
Forget "soft," "medium" or "firm." The 21st-century toothbrusher now faces a mind-boggling array of options, from "gum stimulators" and angled bristles to optimally shaped heads and ergonomically designed handles. Such contraptions used to be startlingly expensive -- as much as $130 for a power brush that beeps when proper brushing time has elapsed. But several major manufacturers are creating a new niche: battery-powered toothbrushes, which are much cheaper than the electric kind, but more powerful – and profitable -- than the basic old $2 brush.. .
All this is aimed at manual brushers, who still account for more than 90% of the toothbrush market. The companies think they're more likely to trade up to a $7 battery model than a $50 rechargeable. Manufacturers also see this as a way to gin up revenues at a time when some of their other consumer products aren't growing. . .
But many dentists question whether power toothbrushes are worth the extra expense -- and, tellingly, lots of them still use the old-fashioned kind on their own mouths. Brush makers tout clinical studies -- which they usually pay for and often conduct themselves -- showing that power brushes slough away more plaque than manual brushing. But the American Dental Association says that there's no good evidence that one kind of brush is better than any other -- as long as they are used properly.
"You can do everything you need to do with a [manual] toothbrush and
dental floss," says Kimberly Harms, a dentist in Farmington, Minn., who serves as a consumer adviser to the ADA and who brushes with nothing more than an old-fashioned manual. Irwin Mandel, a professor emeritus at the Columbia University School of Dentistry, also uses a manual. "When you get down to it," he says, power brushes are "to compensate for laziness."
. . .
Dentists say the basic rule for brushing is the same as it has been for decades: Brush twice a day and floss regularly. Brush each tooth surface individually, front and back, using circular motions and paying particular attention to the crevices between teeth. Scrub gently near the gum line, finish by carefully working over the biting surface. This should take at least two minutes.
. . .Consumers comfortable with their $2 or $3 manuals still have a hard time making the leap to more than $10. ("Fifteen dollars for a toothbrush?" said a cashier at a Boston CVS, as he rang up a $15.99 Actibrush. "For that, you should never have to go to the dentist again."). . .(Copyright (c) 2002, Dow Jones & Company, Inc.)
Below is a reference to what my brother says: This is probably the longest article on saliva ever in any daily newspaper: (so this may not just be a fair use excerpt)
The Wonders of Saliva Los Angeles Times, January 21 2002
It protects our teeth, fights infection and is sorely missed when absent. Scientists are fascinated by its medical potential.
by Rosie Mestal, Times Medical Writer
Saliva is a humdrum liquid, the stuff of giggles, dribbles and schoolyard grossness. It's hardly something to take seriously--until, that is, you lack it. When your glands no longer pump out a normal and robust 2 to 3 pints daily, then you'll come to appreciate spit for the wondrous substance it is--one that does far more than render food slimy and digestible.
Saliva, science has revealed, is much more than water. It is packed with proteins that help control the teeming hordes of microbes in our mouths. It is stuffed with substances that make our spit stringy, stop our teeth from dissolving and help heal wounds. It is brimming with a plethora of hormones and other chemicals revealing anything from whether one smokes to whether one is stressed.
Thus it's no wonder that trouble starts brewing when mouths dry out. Cavities blossom like flowers in spring. Tongues become sore and fissured, and breeding grounds for yeast. In a spit-depleted world, speaking and swallowing are challenges, eating a cracker is the height of recklessness and you wake up with your tongue glued to your mouth. Such indignities will be more frequent in future years because the number of saliva-depleted people stands to rise, experts predict. Tens of thousands of Americans receive radiotherapy for head and neck cancers each year--a treatment that can permanently damage salivary glands. Maybe a million have dry mouths because their immune systems are attacking their own glands in a disease known as Sjogren's syndrome.
But an increasing number of people (25 million by some estimates, and more to come as the population ages) get dry mouths as a side effect of more than 400 of today's medications--taken for depression, high blood pressure and more.
A small band of scientists is fighting back.
Armed with a deep knowledge of saliva gleaned over decades, this cadre--which jocularly refers to itself as the "salivation army"--is working to create better artificial salivas to keep mouths wet and protected and find new drugs to help saliva flow more freely. They're trying to repair salivary glands with gene therapy--even to build an artificial gland to implant in the mouth.
And their vision goes far beyond simply mending the mouth. Just as leech saliva gave us anticoagulants, researchers hope that our very own spit may yield new antimicrobial drugs to help battle germs. Or that sick people's salivary glands can one day be coaxed to make hormones that are needed for their bodies to heal.
"The field's quite exciting--we're entering a new phase," says Lawrence Tabak, a longtime saliva scientist and director of the National Institute of Dental and Craniofacial Research. "People are trying to translate what they've learned from nature into things that are going to improve patients' health. To me, that's the most exciting thing possible--to take these great, basic science discoveries and translate them into tangibles."
Tangible breakthroughs on the saliva front can't come too soon for Nancy Ross-Flanigan, 52, a Detroit area writer who's been pretty much spitless for 11 years, ever since her salivary glands were blitzed during radiotherapy for tongue cancer.
Nothing, she says, prepared her for just how dry things would be.
"I just assumed--well, everybody has dry mouth when they get nervous or something--that's what I thought it would be like," she says. "That you could still talk. You could still eat. You wouldn't have to be putting something in your mouth all the time to have any moisture."
But her mouth ended up so dry it wouldn't yield spit even when doctors tried milking her glands with a suction cup stuck inside her cheek. Unless she sipped water every few minutes, her mouth gummed up, her throat got scratchy, she croaked, and then she choked. Life's most humdrum events became tinged with new drama.
She learned to favor slimy pastas and soups after a series of spectacular restaurant choking incidents--and a time, on a lunch date, when a wad of bread wedged fast under her lip, bulging it out like a chipmunk's cheek.
She experimented with a long stream of over-the-counter mouth moisturizers that her friends jocularly referred to as "I Can't Believe It's Not Saliva!" She tried a drug to stimulate her glands. It left her saliva flow almost unchanged but sent other bodily secretions into overdrive, drenching her with sweat in the grocery store or office.
Today, Ross-Flanigan uses over-the-counter pills that coat her mouth with slime--but mostly she just totes water everywhere. She carries it in sundry bottles, plastic jugs and on a pouch on her back when she rides out (not quite as wild and free as she'd like) on her Harley motorcycle.
It is far from ideal. Water isn't slick like saliva, so her mouth gets dry and sore. Sinister scenarios color her fantasies of overseas travel: "I think, 'Gee, what if I get captured by terrorists and they won't let me have my spit bottle?'"
And sometimes, she says, she just feels plain dorky. Like the time she went backstage to meet her rock idol, Joe Cocker. There she was, dressed to the sexy nines in spandex skirt, slinky top, strappy shoes--accessorized by a giant, red, plastic picnic jug.
Few people suffering from dry mouth are quite as desiccated as Ross-Flanigan. But they can still run into nasty trouble, says saliva expert Mahvash Navazesh, associate professor and chairwoman for oral medicine and oral diagnosis at USC's school of dentistry (and possibly the only person to possess a plush teddy bear with "spit queen" inscribed on it).
She holds up slide after slide depicting only too clearly what she means--raw tongues white with yeast, teeth brown or black with decay on their ridges as well as at or under the gumline, where decay is usually rare.
If only, she says, more dentists and doctors had saliva at least somewhat on their minds.
"I don't think people are paying enough attention," she says. "Because of that, dentists are usually doing damage control. They are treating dental problems rather than preventing them."
Early Diagnosis Can Mean Saving One's Teeth
To Navazesh's mind, the first part of paying attention is measuring saliva flow properly so you know if there's a lack--and she is an expert at that, demonstrating her craft one morning on a well-dressed, middle-aged woman who has been referred to USC with a suspected saliva shortage.
At Navazesh's request, the patient sits in the dentist's chair, head tilted upward, eyes open, and drools into a tube for five minutes. Next she chews gum for five minutes in time with the click of a metronome--and spits into a second tube. Finally, she sucks a lemon candy (again in time with the metronome) and spits into tube No. 3.
The tubes are weighed--the first holding a dribble, the second an inch, the third nearly two--and saliva output calculated. Finally, the verdict is delivered: The patient's flow is on the low side and could indicate an early stage of Sjogren's syndrome.
Diagnosis is crucial, experts say, because there are things patients and dentists must do to fight rampant tooth decay. Stringent oral hygiene is key--brushing and flossing after every meal, daily application of fluoride gels, monthly tooth-cleaning appointments.
"I could have gone around the world four times on the money I've spent on my teeth," says art teacher and Lakewood resident Ruth Eyrich. Her Sjogren's syndrome was diagnosed in 1985 after her dentist found more than 14 cavities on one tooth and asked her what the dickens she'd been doing.
Yet despite monthly visits to the hygienist and everyone's best efforts, she says, her teeth have slowly crumbled over the years--through a long procession of fillings, crowns, root canals, bridges and 13 dental implants. She pores over the pages of "The Moisture Seekers," a Sjogren's newsletter, and hopes one day she'll read of a big breakthrough.
It hasn't come yet.
Thus, along with diagnosis and care, a third line of attack is needed to help the dry mouth brigade--one that's been sorely neglected, say scientists. Better therapies.
"A lot of my patients are suffering--there's no good answer for them," says Nelson Rhodus, director of the Oral Medicine and Xerostomia Clinic at the University of Minnesota in Minneapolis.
Drug companies continue to neglect the dry mouth arena, he says, because they don't see much money in it. And today's gland-stimulating drugs can only help people with glands left to stimulate.
Artificial salivas, unimpressively, have fared no better than tap water in most clinical trials.
It's time, experts say, to bring more science to bear.
A Relatively Recent History of Study
Saliva science kicked off relatively late in the history of medicine, recounts Irwin Mandel, grand old man in saliva research and somewhat of a historian on salivary matters.
Centuries before Mandel got his hands wet in the lab, physicians thought the salivary glands were lowly excretory organs--ridding the body of toxins and evil spirits from the brain. They would dose patients with poisonous bichloride of mercury, causing saliva to pour from the mouth.
Even in the last century, scientists only got serious with saliva well after they'd tackled other bodily fluids like blood.
("Saliva doesn't have the drama of blood, it doesn't have the integrity of sweat, it doesn't have the emotional appeal of tears," says Mandel, a professor emeritus of Columbia University.)
But from the '50s onward, Mandel and a handful of others have established that human saliva is filled with hundreds of useful chemicals, floating around with millions of bacteria, viruses, yeast and skin cells in what Mandel terms a "chowder." They've been busily investigating such proteins--and finding that some are important for maintaining oral health.
There are long, sticky and stretchy proteins called mucins that are studded all over with carbohydrates, giving saliva its stringiness so it nicely coats the teeth and gums. Mucins are a royal pain to study, says Paul Denny, a saliva molecular biologist at USC. ("They stick to everything," he says with a sigh.) But they're worth it.
Studies from various labs suggest that mucins do more than form a physical barrier protecting the teeth. They also stick to bacteria that cause tooth decay and gum disease, interfering with their ability to colonize teeth, and helping our immune cells attack them.
And mucins are just the tip of the iceberg. Other proteins--with names like peroxidase, lysozyme, lactoferrin and histatin--as well as our own antibodies also wreak havoc on bacteria and fungi.
Some salivary proteins, such as one fondly referred to as "slippy," hasten the healing of wounds. Some ("slippy" again, among others) neutralize viruses like HIV.
Others keep saliva super-loaded with calcium and phosphorus, the stuff of tooth enamel, so these minerals don't leach from teeth.
"If saliva were water, we would have little stumps of teeth or no teeth at all by age 20--we would have dissolved our teeth away," says Frank Oppenheim, chairman of the department of periodontology and oral biology at Boston University.
Some of these proteins have been studied in small trials--such as the histatins, long Oppenheim's passion, which inhibit the growth of yeast and bacteria.
In one histatin study, beagles were first brought to the heights of oral health by rigorous daily toothbrushing. Then, for 42 days, they ate a diet causing plaque buildup, and either received histatins in an oral gel or the gel alone. At the study's end, those given histatins had developed less gum inflammation and plaque than the other group.
In another trial, 159 healthy humans refrained from brushing their teeth for four weeks. Yet again, those using a mouth rinse containing a portion of the histatin protein developed less plaque and gum inflammation than those who didn't.
Currently, a Pittsburgh company, Demegen, is developing a histatin mouth rinse--one that could be used to fight oral yeast infections in people with faulty immune systems.
But some researchers hope that knowledge of spit proteins could improve the quality of artificial salivas--both in terms of texture and cavity-fighting clout. Today's faux salivas usually contain a synthetic thickening chemical--but it makes the fake fluids too thick, says Rhodus. ("If people have cotton-mouth to begin with, using this stuff is like putting glue in there.")
With both types of improvements in mind, Dutch scientists, among others, are busy testing sundry fake salivas seasoned with this or that microbe-fighting protein. They've developed fake salivas containing synthetic gums or mucins harvested from pig stomach, which are appreciated for their slithery feel.
But it's tough to create anything close to a fluid that's been fine-tuned through millions of years of evolution, says Arie van Nieuw Amerongen of the Academic Center for Dentistry in Amsterdam. The pig mucins, for instance, are sticky enough but just aren't stretchy enough.
"Hardly anybody thinks about spit. But when they miss it, they see how many properties it has--and how difficult it is to mimic," he says.
Rats: Gene Therapy Is Still a Long Way Off
Instead of mimicking saliva, some scientists want to fix the faucet and get fluid flowing again, using gene therapy. Ross-Flanigan has heard of that: She's even got some clippings about it in her "saliva" file. She'd do it in a flash if she thought it would work.
So far, though, only rats have really had their dry mouths cured, says Bruce Baum, chief of the gene therapy and therapeutics branch of the National Institute of Dental and Craniofacial Research.
The rats (whose glands were first destroyed with irradiation) didn't grow spanking-new glands. Instead, tissues that don't normally ooze fluid were genetically changed into oozers.
The approach: infecting those watertight tissues with a harmless virus carrying a special gene, called aquaporin. Aquaporin directs the formation of a protein that muscles its way into the membrane and forms a pore through which water can pass.
Rats may be curable, but Ross-Flanigan won't be able to get the blitzed remains of her glands studded with water pores any time soon. The strategy hasn't yet been shown effective in pigs and primates, let alone tested in human trials.
Gene therapy, in any case, isn't the only saliva science exciting Baum. His group is also working hard on an artificial gland--one that would be built from scratch out of skin cells engineered to ooze fluids. The cells would be coaxed to grow on a biodegradable tube that would then be implanted in the mouth.
Baum and an Alameda biotech company, Genteric Inc., are also excited at the thought that salivary glands can be used as little factories. The glands, both point out, don't just ooze fluid and proteins into the mouth. They ooze them into our blood.
Thus, while you could certainly add genes to improve the quality of someone's saliva, you could also add genes that would help supply hormones for the rest of the body: growth hormone, insulin, you name it.
In fact, says Tabak, you can dream on and on about stuff one can do with this lowly fluid and the glands that make it. Maybe one day scientists will find a salivary gland stem cell and build whole new glands from scratch. Maybe one day all those hormones that are floating around in our spit will allow engineers to build tiny sensing devices that sit in our mouth, constantly monitoring our health and telling us off if we light up a cigarette.
"Imagine it telling you, 'Go see your physician' or 'Danger: You Have Taken in Too Much Alcohol,'" Tabak says. "You can fantasize about all kinds of things."
A Substance of Substance
Nerve signals from the brain prompt the three main pairs of salivary glands (the parotic, sublingual and submandibular) to release saliva. The taste, sight or even thought of food increases the signals.
What's In It
Saliva contains hundreds of proteins and other chemicals with a wide array of properties. Among them:
* Mucins, proteins that make saliva stringy, protecting the teeth and gums and fighting bacteria.
* Histatins, lactoferrin, lyzozyme and peroxidase, proteins that appear to fight bacteria and yeast.
* Proline-rich proteins that allow large amounts of calcium phosphate to exist in our saliva--preventing our tooth enamel from dissolving.
* Amylase, an enzyme that breaks starch into sugars and begins digestion of food before it reaches the stomach.
* Chemicals such as epidermal growth factor and one called SLPI (or "slippy"') that aid in wound healing.
* Hormones and drugs that reveal much about our physiology, making spit useful in crime and medicine.
Among ancient peoples, it is said, this precious bodily fluid was used
as the basis of a primitive lie detector test. The accused would be given a
handful of rice and told to swallow it; if he couldn't, it meant he was
nervous - and guilty.
This slippery stuff also helps moisten and digest food, and has healing
powers as well - proteins that fight bacteria, fungi and viruses and others
that speed tissue healing, says Dr. Irwin Mandel, professor emeritus at
Columbia University. In fact, animals that lick their wounds heal faster
than those who don't.
The fluid in question, of course, is saliva, or actually, spit - a
combination of the saliva pumped out by salivary glands and all the other
effluvia floating around in our drool: drugs (licit and otherwise), bugs
(viruses, fungi, bacteria), hormones, antibodies and anything else small
enough to seep out through tiny blood vessels into the mouth.
As unpleasant as it all sounds, spit is in. In fact, it could be the
diagnostic fluid of the future, according to scientists who plan to gather
next week at the National Institute of Dental and Craniofacial Research to
explore spit's many wonders - and economic potential.
Already, a number of companies are using the Internet to tout spit test
kits, some of which have not been approved by the US Food and Drug
Administration, which acknowledged last week it's scrambling to keep up.
With the kits, consumers muster a little spittle, fork over $60 or so and
send the sample to a lab to find out whether, say, their testosterone is
tanking, their estrogen slipping, or their stress hormones soaring.
Spit, or more elegantly, oral fluid, is almost identical to the clear part of blood, but with everything - including infectious organisms - present in
weaker concentrations. In the past, diagnostic tests were not sensitive
enough to detect these low concentrations, but now they are.
That means that almost anything that can be detected in blood can
theoretically be found in spit, too - with less pain, risk of infection and
expense.
Spit testing is cheap because it's so safe - neither patient nor health
care worker can get stuck with a needle. "You don't need a technician to
get the sample," says Dr. Stephen Sonis , chief of oral medicine at
Boston's Brigham and Women's Hospital.
So far, spit tests have only been FDA-approved for a few limited uses - to detect the AIDS virus, illegal drugs, alcohol, a hormone that signals
premature labor, and periodontal disease. There are no tests that allow a
person to both collect and analyze spit at home - yet.
With the OraSure kit made by the Epitope Corporation of Beaverton, Ore.,
for instance, you have to go to a health care professional, who puts a
toothbrush-like swab between your cheek and gums for a few minutes, then
sends the sample to a lab to be tested for HIV. Insurers also use the
OraSure kit to test for marijuana, cocaine, opiates or methamphetamines.
In other countries, the kit is used to collect spit for testing for
hepatitis B and other diseases. And soon, this kit and others like it could
be used to get DNA for testing from prisoners on parole or people at risk
for genetic diseases. (It's unlikely, by the way, that spit samples could
be collected surreptitiously from, say, a coffee cup or eating utensil,
because the sample would be too small and would degrade quickly without
preservation.)
But as spit collecting and preservation techniques evolve, do-it-yourself
spit tests could be commonplace.
Already, doctors use spit tests to monitor hormonal changes in infertile
women, says Dr. Philip Fox, former clinical director at the National
Institute of Dental and Craniofacial Research at NIH and now research and
development director at Amarillo Biosciences Inc., in Amarillo, Tex.
Similarly, SalEst , made by Biex, Inc. in Dublin, Ca. allows women at risk of premature labor to have their spit tested by a doctor for the hormone
estriol. If estriol rises before 36 weeks of pregnancy, it's a signal the
woman may go into labor prematurely.
But it is the gray area of spit testing through companies on the Web that
concerns the FDA, which worries about consumers putting their trust in
diagnostic tests that have not been approved.
The Great Smokies Diagnostic Laboratory in Ashville, N.C., for instance,
offers spit tests for a number of hormones through its Web site ( BodyBalance)--You pick the test - StressCheck, MaleCheck or FemaleCheck - pay $60 and send in your sample to see if your hormones are in the normal range. No doctors are involved.
The company claims the tests are "screening" tools, not true diagnostic tests, and admits its tests are not approved by the FDA. After inquiries from the Globe, the FDA said it is "concerned about the Great Smokies advertising and promotion as well as about other firms that advertise and promote lab tests on the web."
While it is not illegal for labs to set up an in-house testing service and offer it through health care professionals, it is illegal is to offer this service directly to consumers, says Dr. Steven Gutman , director of the FDA's division of clinical laboratory devices.
But "the beauty of the test" for consumers, argues Dr. Alison Levitt, a physician at Great Smokies, is precisely that "you don't need to go to the doctor. . .People are interested in their hormone levels. People want
numbers."
Aeron LifeCycles Clinical Laboratory in San Leandro, California used to offer spit tests directly to consumers, too.
But last year, after federal and state regulators reviewed the lab's practices, the company decided to put doctors in the loop, though you still don't need to actually talk to a doctor to be tested, notes George Romero, customer service manager.
You simply send in your spit and $44, pick a name off a company-supplied list of doctors and that doctor signs the test order. For an additional fee, that doctor will help interpret the results, which you also get sent directly.
But how useful is it to send off some spit and get a few numbers that you try to interpret? Probably not very - in part because some hormone levels fluctuate wildly.
To test for stress, for instance, the Great Smokies lab checks levels of two hormones, DHEA (dehydroepiandrosterone) and cortisol. But cortisol levels vary over a 24-hour cycle, so if you send in only two samples a day, as the company website suggests, the potential for misinterpretation would appear to be high. In the version of the stress test sold to doctors, hormones are measured four times a day, says Great Smokies physician Levitt.
For researchers, however, it is precisely this variability in hormone levels that makes spit-tests a gold mine because they can track physiological changes almost in real time.
"When cortisol goes up in the blood, we find it in saliva within 20 minutes," says Douglas Granger, a Pennsylvania State University behavioral endocrinologist. In studies of people before and after roller coaster rides, cortisol in saliva shoots up within 15 minutes, then returns to normal in an hour.
In other work, Granger has found similar cortisol spikes in kids experiencing family stress.
In one test, he asked mothers and kids to discuss a topic about which they disagreed, then had the kids spit into little cups. The kids judged the most anxious by other tests showed the highest rises in cortisol levels, says Granger, who has formed a research company to study spit for a number of hormones...
Ultimately, with more sophisticated spit kits, consumers could test their oral fluids at home. What spit testing offers, says, Dr. Irwin Mandel, affectionately known among researchers as "the grandfather of spit," is "a lick and a promise"- a simple, reliable way of monitoring health.
Take care in getting tested.
If you decide to have your oral fluids tested, especially by one of the services offered on line, be wary:
- When collecting the spit sample, follow package directions carefully. Typically, spit samples must be preserved quickly to remain useful. (For instance, if you've just eaten or drunk something, rinse your mouth and wait a few minutes before collecting spit.)
- Think about potential confidentiality problems. Anytime you reveal medical information on the Internet or send bodily fluids through the mail, your confidentiality may be at risk.
- Remember that a number of medical treatments and conditions, including drugs, radiation therapy, autoimmune problems such as Sjogren's syndrome, can affect saliva. This could influence the accuracy of your tests.
- Most important, if you bypass a doctor and use the Internet to find a spit test service on your own, you could be jeopardizing your health. If you're sick - or worried that you might be - call a doctor.
Copyright 1999 Globe Newspaper Company
The Biology of ...Saliva: Just Say ’Ahhhh’ Discover Magazine, Vol. 26, No. 10, October 2005
by Kathleen McGowan
“Most people treat saliva with disdain, as a nuisance more than anything else,” says Irwin Mandel, professor emeritus at the School of Dental and Oral Surgery at Columbia University. “They don’t realize how important it is. Those who have an absence of saliva are miserable.”
The Image of Dentistry in Contemporary Culture by Dr. Irwin D. Mandel from Journal of the American Dental Association, May, 1998, "Reprinted by permission of ADA Publishing Co., Inc." Abstract:
The multimedia portrayals of dentists and dentistry have expanded in scope. Prevention and esthetics have replaced drilling and extraction in the public perception of dental practice. According to Dr. Mandel, dentists themselves are no longer treated exclusively as buffoons or sadists. Instead, he writes, they are more apt to be seen as solid citizens, occasionally as romantic figures and even as complex, realistic human beings.
A perfect smile is rapidly becoming the American icon. Even, white, sparkling teeth, set in pink, firm gums - a visage reserved in previous generations only for denture wearers and Hollywood stars with capped teeth - has now become the hallmark of an affluent society, pervasive in all the media and a basic requirement for anyone appearing before the public. A new species has emerged -- dentaurs -- half human, half teeth. Indeed the toothsome smile recently graced the front cover of the New York Times Magazine, highlighting a special issue, How The World Sees Us.(1) The introductory statement reinforced the symbol: "Our technology -- computerized weapon systems, medical scanners, the internet -- sets the standard to which developing nations aspire. Even our teeth, gleaming, beveled, orthodontized into orderly white rows, are the envy of the world." (See Figure 1 -- sorry no figures - so you miss "An ideal dentition").
Increasingly, writers refer to dental appearance to contrast American with other societies. Miklos Vamos, a Hungarian writer teaching in the United States, is awed by the smiles he sees around him at social gatherings. Referring to another guest chatting with him: "You can't say a word. You are looking at her smile and thinking about your little country. Oh, if we could smile like that ... we have neither teeth nor gums for it. There's a lot to do, a lot to learn yet."(2)
Michiko Kakutani's New York Times review of the book Cafe Europa: Life After Communism by Slavenka Drakulic was titled "Soul of Croatia is Bared in its Teeth."(3) The review notes the pervading image in the book is "a nation of bad teeth." The author, a Croatian journalist returning home after a visit to the United States, noticed something she had not been aware of before: her friends, relatives, acquaintances and neighbors all had terrible teeth. Ms. Drakulic sees this as a metaphor for much that is wrong with post-communist Eastern Europe, a metaphor for failure of people to develop a sense of individual responsibility. The author recognizes that: "bad teeth are the result of bad dentists and bad food, but also of a specific culture of thinking, of not seeing yourself as an individual. What we need here is a revolution of self-perception."
Clearly in this country in the past 50 years there has been a revolution in dental self-perception. Thanks to preventive dentistry and its successes, the view that tooth loss was the inevitable consequence of aging, so dominant in previous generations, has been replaced by an expectation of tooth retention, comfort and attractive appearance. Spectacular advances in esthetic restorative materials and techniques, including adult as well as child orthodontics, has made optimal appearance as well as optimal function attainable, at least for those who can pay for the services (See Figure 2 - sorry you're missing "Esthetic dentistry: A growing component of
current practice"). Contemporary culture reflects these changes, and dental images abound, not only in the pop culture of movies, television and magazines, but in literature, drama and art.
Images of Preventive Dentistry
Until a few decades ago the public image of the dentist was primarily as an extractor of teeth, not surprising since tooth drawing has been the major means of dealing with dental pain for almost 5,000 years.(4) It has been a favored subject of artists, caricaturists, cartoonists and photographers around the world. Dentists' involvement with prevention and oral hygiene also has a long history.5 Dental advertising stressing techniques of personal tooth care have been commonplace for several hundred years, but it has taken all this time to become truly part of public perception and daily ritual. Now, consumer advocates and health care writers stress prevention and avoidance of dentists who are "quick on the draw." They recommend that "patients choose preventively-oriented dentists who teach you how to brush properly and use dental floss to remove plaque and fight periodontal disease from the start."(5) Tooth preservation is the prevailing motif.
Thanks primarily to fluorides, improved hygiene and diet it is no longer commonplace to pay for the sweet life through the teeth. With the dramatic reduction in caries, drilling and toothache have faded as cultural targets. In their place periodontal disease is gaining greater public attention and becoming a metaphor for our society with its progressive loss of support systems, and dental floss is viewed as part of the safety net.
This new image is most evident in cartoons and comic strips. The caption for a cartoon depicting a typical cocktail party conversation reads: "Believe me, a radical restructuring of society isn't necessary. An awful lot can be accomplished by regular flossing."5 In another cartoon picturing several people marooned on a desert island, a hovering plane is dropping supplies. A parachute settling to earth carries a box labeled "Dental Floss".(5)
In a Doonesbury comic strip featuring the 60's generation, Dr. Dan Asher, the Baby Boomer's Boswell is asked: "what's the ever-trendoid boomers up to these days. What's on their minds?" The response is "gum disease. Dental floss is totally hot."(6) (See Figure 3 - sorry you miss this 1985 image)
Floss is insinuating itself into movies as well. In Pretty Woman, a very adult fairy tale, Julia Roberts plays an upwardly mobile prostitute. A scene set in the bathroom of her very wealthy client Richard Gere, has the audience expecting that she is taking dope. Instead she's shown busily flossing her teeth -- accomplishing more in 30 seconds than Johnson and Johnson did in 30 years of advertising.(7) In Up Close and Personal, Robert Redford and a colleague are discussing a fellow T.V. newsman in a disparaging manner. Redford notes that: "He never made the Grenada invasion -- it coincided with an unbreakable periodontist's appointment." The colleague comments: "The flossers are in charge now."(8)
Although dental floss is now "in", there was one instance in which it was "out". The Associated Press reported the case of a prisoner in West Virginia who escaped from jail by scaling an 18 foot fence with the aid of a rope made of dental floss. He had braided accumulated floss to the thickness of a telephone cord. Dental floss was subsequently taken off the shelves of the jail store.(9)
Oral hygiene and its rituals are encountered with increasing frequency in contemporary literature, often reflecting the personal involvement of the writer in dental care. John Updike for one has mined his dental lode of personal experiences in numerous literary offerings, and oral hygiene is well represented.(10) In the novel S, the narrator Sara Worth, has left New England to join a commune in Arizona.(11) The book is structured as a series of dispatches that include her family, hairdresser, psychiatrist and dentist, as she attempts to maintain a link with her old life while striving to create a new one. The letters to the dentist -- breaking a scheduled appointment for a cleaning and postponing subsequent maintenance visits -- contain assurances that she's still flossing regularly with unwaxed dental tape and using a rubber tip for her gums so she won't have to "go through all that surgery once again! Once was enough!!"
Updike's short story Tristan and Iseut consists entirely of a description of a visit to a new hygienist in his dentist's office for his regularly scheduled cleaning.(12) The hygienist and the process is described in exquisite detail. He notes "the double barrier of her glasses and safety goggles above the shield-shaped paper mask hiding her mouth, her chin, her nostrils. So much of her was enwrapped, protected. Only her essentials were allowed to emerge, like a barnacle's feathery appendages -- her touch and her steadfast humorless gaze." He goes on to describe "her flurry of searching out the last potentially disastrous plaque in the remotest crannies of his upper left molars ... and then the polishing, with its playful cares of microscopic grit, and the flossing -- quick, brusque, nimble around and under the bridges -- felt anticlimactic. Without the threat of pain their encounter became small, much as the childish perpetrators of giant agitated shadows, in an attic or a summer camp shack, shrink when the candle is put out." Hardly a textbook description of a dental prophylaxis. After all, textbooks are never written from the patient's point of view.
Preventive dentistry and especially oral hygiene figures prominently in Rameau's Niece by Cathleen Schine.(13) In this witty and delightful novel several chapters involve the protagonist's relationship with her dentist (professional and otherwise). She describes one visit: "He tenderly handed her samples of dental floss, as if they were the host and he a prophet of a particularly mighty god. He scolded her for past transgressions against her teeth, and worse, her gums. He encouraged her with the possibility of redemption through quarterly curettage."
Some writers preferred sacrilege to religiosity. Phillip Lopate in his long poem, In The Dentist's Chair,(14) musing while he has his teeth cleaned, rebels against the advised regimen -- at least for the moment.
"Besides, I feel I've made enough concessions.
Let my teeth fall into rags
I won't become their slaves. And if she nags
me anymore, its tell them what I think of
their profession.
"Fanatical mechanics with their self-righteous airs --
Anti-communists of the mouth, waging holy wars on plaque,
I wouldn't be surprised if it were all a quack!
and a century from now, some bright Lavoisier
"Will come along and prove
that plaque was an illusion, like phlogiston.
- Calm down, you're begging the question.
It's your reflex perversity you so love."
Much more reflective of the public image of preventive dentistry is the announced availability of a new Barbie Doll -- Dentist Barbie. "Dressed in a white dentist's coat dress, Dentist Barbie gives positive feedback to her patient, with two different phrases, "let's brush, and "great check up!" says the press release. "Her fully poseable upper torso enables her to simulate brushing, and girls can activate sounds of tooth brushing and water spray while Barbie treats her patient."(15)
Shorn of its consumerism the new Barbie Doll is a recognition of the accomplishments of preventive dentistry. A generation ago a recent short story wouldn't have included this description - "Years of fluoridated water, decay-preventing dentifrices and orthodontia had worked their magic. Whiter than new snow, more uniform than kernels of hybrid corn, brighter than Venus, Jupiter, and Mars in alignment, their teeth alone would have revealed them as the cheerleaders they were."(16)
Dentists and Dentistry -- Contrasting Images
For most of this century the prevailing image of dentists and dentistry in popular culture has been characterized as demonic or comedic.(17) A recent survey of dentistry as portrayed in motion pictures and television supported this view. The authors concluded that with few exceptions dentists and dentistry were depicted as figures of humor and derision or as brutal sadists -- "images consistent with those presented throughout recorded history: fear and humor."(18) Like all generalizations these appraisals obscure the shadings and exceptions. There are numerous examples of dentists portrayed as real people, with person as ranging from dull to suave, and variations in between. Descriptions of dental practices run the gamut from frightening experiences to erotic ones: from simple silver fillings where the dentist "is concerned with keeping a dab of silver on the end of a tiny club-shaped tool,(19) to complex reconstructive procedures that serve as a metaphor for social engineering as in Local Anaesthetic by Gunter Grass.(20) Dental images are as contrasting and complex as life itself.
The most common cultural stereotype of dentists today is bland -- the epitome of middle class respectability. It was essentially true in previous generations as well, but was overshadowed by the exaggerated roles often assigned. In the 1938 play Rocket to the Moon by Clifford Odets(21) the entire action takes place in the office of Dr. Ben Stark, an unhappy dentist who feels constricted by his general practice (a prison-office in the playwright's view) and an unsatisfactory marriage. The drama is generated by Stark's conflict between a sense of obligation to his wife and an attraction to his dental assistant, a pretty, aspiring dancer who represents the romantic and creative forces missing from his life.(22) Twenty years later Graham Greene in The Complaisant Lover introduced us to Victor Rhodes, a successful English dentist totally committed to his profession.(23) As played by Sir Michael Redgrave (in both London and New York) he is seen initially as bumbling and foolish, but by the end of the play Greene treats him respectfully and seriously and allows him to gain the audience's sympathies. It is Rhodes who resolves the triangular dilemma that is the core of the play into an acceptable form.(22)
One play, in the 1960's, did depart from the tradition and cast the dentist as the central character who was a suave "swinger" -- Cactus Flower, adapted from a French comedy by Abe Burrows.(24) In the Broadway play the Park Avenue dentist is an attractive bachelor Lothario (played by Barry Nelson) who weaves a tangled web of romantic deceit to avoid permanent entanglement in his current affair. In the movie version, the dentist role was played by Walter Matthau, better known for comedic than romantic roles. Apparently Hollywood was concerned that the subliminal attitude of general movie audiences was different from than of upscale Broadway viewers. The producers may have been correct. The Broadway Cactus Flower never started a trend.(22)
Today dentists, like accountants, are still veritable clichés for dull, non-threatening solidity and stolidity. In a recent novel About Schmidt, by Louis Begley,(25) the protagonist observes: "There is a race of men -- all federal and state bank employees, and most dentists -- who are born to retire. They aspire to retirement from the moment they are born. Golf clubs, funny shoes and designer sunglasses for the dentist, campers and gas-fired barbecue sets for the employees at the low end of the pay scale." In an affirmation of the cliché, a character in a recent movie says at one point, as someone suggests he should go to the Caribbean: "the Caribbean! Dentists go to the Caribbean."(26)
Not everyone views the blandness as a negative in the literary milieu. In a short story called The Dentist, by Mary Gaitskill,(27) a patient becomes obsessed by the man who has extracted one of her wisdom teeth, described (of course) as a bland, kind guy. The woman, a magazine writer, growing weary of being part of a group of jaded decadents, is drawn to his kindness and even his blandness. She finds herself "longing for her dentist at home with his entertainment center."
Despite the stereotyping, exceptions do occasionally emerge. Infatuation with a dentist is a significant section of Rameau's Niece(17) by Cathleen Schine, referred to earlier. In this case, the dentist is far from bland -- rather a very romantic figure. He is described by the scholarly Margaret Nathan, the central character who lusts after him, as "the beautifully proportioned proselytizing tooth scholar." He is further described as "an extraordinarily handsome man, muscular but without bulk, his face half soft and sensuous, half craggy and almost unnaturally alert. He stood as Michelangelo's David stood, a perfect magnificent copy ... Pigeons would have gathered with pride on Dr. Lipi, so elegantly did he stand."
Not only an Adonis, Dr. Lipi hasd a cable dentistry show called "Eye on Your Teeth" in which "he chatted on about osteoblast and cement corpuscles, Hertwig's epithelial sheath, and the interglobular spaces of Czermak." Truly a model worth cloning by a dental school when regulatory bans are lifted.
Not to be outdone, several films actually featuring dentists in romantic roles have recently appeared. In Eversmile New Jersey, Daniel-Day Lewis (seeking a change-of-pace after his trying role in My Left Foot) stars in an offbeat comedy about a travelling dentists in Patagonia who battles tooth decay with the zeal of a religious crusader.(28) An employee of a "Foundation for the Development of Dental Consciousness," he travels on a motorcycle that converts to a fully equipped dental chair. Billed as a "romantic comedy with a little bite" it unfortunately had only a brief run in theaters, but dentists are beginning to break out of the mold and assume new shapes.
The gender stereotype is also breaking down. In the film Captives, Julie Ormond plays the role of a part-time prison dentist who falls in love and has a secret affair with one of the inmates, Tim Roth. As one film critic described it "Captives gives dentistry a slightly comical erotic frisson, as a routine oral examination turns into a furtive finger to mouth foreplay with intense eye contact."(29)
One of the most realistic and effective treatments of dentists as real people is in the acclaimed novella Age of Grief by Jane Smiley.(30) Its protagonists are husband and wife dentists who met in dental school and now share a practice and a family. One reviewer described it as "explicitly about a marriage in jeopardy, and under its surface, a poignant and rich meditation on the nature of love and change." The integration of dental background, the concerns of practice and the emotional vicissitudes of a marriage are beautifully modulated, and enriched by the dental contribution.
Serious treatment of dental practices in American literature began almost a century ago with publication of Mcteague by Frank Norris,(31) often described as one of the earliest examples of American literary naturalism. The book was later adapted for the screen by Eric Von Stroheim. His film Greed,(32) in which a large gilded tooth hanging outside McTeague's Polk Street (San Francisco) office serves as a pervading metaphor, is considered one of the classics of the silent film era. (See Figure 4 - sorry you miss "McTeague unpacks gold -- gilded tooth.Scene from Greed, (1924) - film based on the book McTeague by Frank Norris (1899) from the Museum of Modern Art/Film Stills Archives.) It has recently been adapted and performed as an opera.(33)
Many books and stories throughout the century contain descriptions of dentists and dental treatment. An extensive analysis is afforded by Theodore Ziolkowski in his classic essay "The Telltale Teeth: Psychodontia to Sciodontia."(34) Numerous articles provide additional examples.(35) In contemporary literature John Updike and Philip Roth provide probably the most frequent references and Gunter Grass's Local Anaesthetic the most extensive.(20)
Updike's personal experiences as a dental patient are detailed in Self-Consciousness: Memoirs(36) and found their way into his novels and short stories.(10) In one of his most popular novels, Couples,(37) a dentist, Freddy Thorne is a major character and there are numerous scenes in his dental office. Although Freddy is pictured as a decidedly unappealing figure personally, he is characterized as an up-to-date competent dentist. Despite some unhappy personal dental memories, Updike is clearly impressed with the accomplishments of dentistry and the skills of dentists. None of his literary dentists are silly, inept or sadistic practitioners: a welcome relief from the past.
Philip Roth's dental interests are best documented in three of his novels -- Letting Go,(38) The Counterlife,(39) and more recently, Sabbath's Theater(40) which has an extensive description of the skills of a periodontist at work. A chapter in The Counterlife concerns the protagonist's brother, Henry Zuckerman, a dentist who appears briefly in other novels as well. It is in his first full-length novel, Letting Go, however, that we are treated to an unusual accolade to the profession. It is enunciated in the voice of the central character's father, Dr. Wallach, a successful upper middle class dentist. On the son's visit home he insists on examining his mouth, and while probing his teeth he says: "I'm acquainted with people who think of dentists as mechanics, carpenters, nobodies. Ridiculous. Dentists are astronomers -- just let me go on -- dentists are geologists. When seen from the proper angle dentistry is a romance ... believe me a tooth is as much a mystery as a star. A man's got to have a philosophy, why he works ... I change people's looks, I give them health and beauty, two of the most wonderful things in the world." He then insists on cleaning his son's teeth -- a muted expression of his overwhelming love.
In Local Anaesthetic, much of the book involves a series of dental visits during which a schoolteacher is undergoing a complex rehabilitative procedure to correct a faulty occlusion resulting from a prognathic lower jaw.(20) Interspersed are frequent soliloquies by the scholarly dentist on dental history, dental materials, the nature of tartar, local anesthesia and the specifics of the restorative procedures. The dissertations on dentistry are leavened by frequent philosophical and political observations. It is a typical Gunter Grass tour de force with the storytelling and its metaphoric implications adroitly intertwined. A sampling: "Just imagine: A dentist and a schoolteacher rule the world. The age of prophylaxis has dawned. Preventive measures are taken against all evils. Since everyone teaches, everyone also learns. Since all are exposed to caries, all are united in the fight against caries. Care and prevention bring peace to the nations. The question of being is no longer answered by religions or ideologies but by hygiene and enlightenment. No more bungling and no halitosis. Just imagine ..."
Grass's book was published more than 25 years ago. The age of prophylaxis is now at high noon. Care and prevention is bringing dental peace and comfort to an increasing number of people. Unfortunately its impact on world peace is not as discernible. What is clear though, is that dental images in contemporary culture have undergone profound changes -- in a very positive direction.
REFERENCES
1. How the world sees us. New York Times Magazine: 1997 (June 8): Section 6.
2. Vamos M. "Being there". The Nation 1990 (May 28): 747-8.
3. Kakutani M. "Soul of Croatia is Bared in its Teeth". In:
"Books of the Times". New York Times 1997 (Feb. 21).
4. Ring ME. Dentistry - An illustrated history. New York: Abrams: 1985:23, 25, 43-5, 47, 137, 150-60, 223.
5. Mandel ID. "Changing Dental Images - From Stone Tablets to Comic Strips". JADA 1989; 118: 695-9.
"My greatest urge is to speak to you of dental care. My generation had a rough go dentally. Our dentists were the Army dentists who came back from World War II and believed that the dental office was a battleground. You have a better chance at dental health. And I say this because you want at night to be pacing the floor because your fuse is burning inside of you, because you want to do your work, because you want to finish that canvas, because you want to help your fellow man. You don’t want to be pacing because you need a damn root canal. So, floss. Use salt and baking soda. Take care of your damn teeth." (as reported in The New York Times, 6/18/2010, ,"Wisdom of Leaders and Guidance for Graduates", by Sam Dillon)
In Movies: (Complete credits at Internet Movie Database):
Akira Kurosawa's I Live In Fear (Ikimono no kiroku) opens with the image of an immediate childish fear – a dental exam. That gets put into perspective when the dentist has to mediate for a family torn apart over fears of the patriarch's insanity, ruin of his business, of eventual nuclear annihilation, and even the destruction of the sun. Made in 1955, it wasn't seen in the U.S. until 1967. (Seen at the Kurasawa Centennial at Film Forum) Balzac and the Little Chinese Seamstress (Xiao cai feng) Charlie and the Chocolate Factory Ghost Town (review forthcoming) (Though released in the summer of 2008, Ricky Gervais’s Upper East Side Manhattan dentist is in effect a Scrooge, an impatient, isolated misanthrope who likes inflicting pain on his patients, until he falls in love with his neighbor.) Empty Nest (El nido vacío) (previewed at 18th New York Jewish Film Festival of Film Society of Lincoln Center/The Jewish Museum) (Noteworthy for a series of fantasies in a dentist's office.) The Hairy Tooth Fairy (El Ratón Pérez) (2006 from Argentina) (review forthcoming, as seen at Tribeca Film Festival) (I’m looking, around the house and online, for the citation of the two-part article my father did on the history of cultural traditions for baby teeth, including the European mouse that this delightful animated/live action family film draws on. Here the baby teeth are further imagined as being turned into special pearls which are sold to garner the coins left under children’s pillows. Interestingly, the villain who wants to control Senor Pérez for his own financial gain operates in a dentist-like chair.) Into the Blue Reign Over Me (review forthcoming) (Among other points in this muddle, Don Cheadle’s cosmetic dentist’s mid-life crisis does not result in him realizing that he can do more in dentistry than veneers, but only that he can beat back a false inappropriate sexual advance charge and boss around his colleagues.) The Secret Lives of Dentists A Serious Man (2009) The Coen Brothers explain the fable of the dentist. Simon (2004 from the Netherlands) (review forthcoming) Syndromes and a Century (Sang sattawat) (2006 from Thailand) (review forthcoming) Whole Nine Yards Wolfsbergen (2008 from the Netherlands) (review forthcoming, as seen at Film Society of Lincoln Center’s Film Comment Selects) – A dentist gets quite House-like in challenging a patient about her flossing habits, but, hey, his marriage is falling apart and family imploding.
On Television (Complete credits at Internet Movie Database):
A blogger's Top Moments in TV Dental Comedy: 5. Happy Days, Season 8, Episode 10, "It Only Hurts When I Smile"; The Brady Bunch, Season 1, Episode 20, "Brace Yourself"; The Cosby Show, Season 2, Episode 16, "The Dentist"; Bill Cosby, stand up routine; and The Carol Burnett Show, Tim Conway and Harvey Korman doing "The Dentist Skit".
"Mr. Monk and the Dentist" (Episode #60, Season 4, teleplay by David Breckman and Tom Scharpling, story by Daniel Dratch and Joe Toplyn, directed by Jefery Levy) is a funny satire of Marathon Man, with Jon Favreau as the dentist torturing "the defective detective", in the USA cable series about obsessive-compulsive Monk.
Desperate Housewives - from the end of the 2nd season into the 3rd season of the suburban satire has "Orson Hoge" as a psycho, detail-obsessive murderous dentist who gets his just desserts.
Ugly Betty’s first season finale “East Side Story” by Marco Pennette and Silvio Horta in May 2007 featured a funny chick flick-obsessed dental hygienist played by Kristen Chenoweth (she’s particularly fond of Julia Roberts having used dental floss in Pretty Woman “before she whored herself out to Richard Gere”), who figures out that “Betty”s geeky dentist (confusingly also identified as her orthodontist as her extensive braces and night retainer are singular identifiers of her titular appearance.) “Dr. Farkas” was having an affair with “Betty”s hoped-for-love’s girlfriend – and “Betty” had even introduced them at a party a couple of months earlier, he played by Jesse Tyler Ferguson in the “Icing on the Cake” episode by Jeff Melman. They’d had an amusing interchange then: “Dr. Farkas”: OK, Betty. All done. So now these new wires are a different gauge. So they may feel a little strange to you and to anyone who's kissing you.. “Betty”: Oh, Dr. Farkas. Nobody's kissing me. Dr. Farkas: Aww, come on. There must be someone special. “Betty”: Well there was a guy, but, he has a girlfriend. “Dr. Farkas”: So, uh, how's it feel? “Betty”: Well it was tough at first, but, now I'm happy. We're all just friends. “Dr. Farkas”: No, I meant the braces.
In the final season's "Million Dollar Smile" by Chris Black and Henry Alonso Myers, broadcast 3/24/2009, she dreams that her orthodontist "Dr. Frankel" (Kathy Najimy) shows how perfect her life would be (and how worse off everyone else would be) if she had never needed braces and was beautiful with perfect teeth.
In the third season finale of Lost, in May 2007, there was a revelation about the oldest plane crash survivor, as he prepared to utilize his skeet shooting experience in joining in the defense of the beach camp against The Others: “Bernard”: I'm a dentist, I am not Rambo. His wife “Rose”: And don't you forget it!
Law and Order: Criminal Intent - in “Smile” by Warren Leight and Charlie Rubin, first shown on USA October 18, 2007, Episode #136 in the 7th season, a murdered dentist is first accused of pedophilia as the reason he has a Bronx practice in addition to his Park Avenue office. His murder was facilitated by his addiction to nitrous oxide, but his young patients have really been dying due to the tainted mouthwash samples that had been donated to his office he had passed on. A year later on the 3rd season opener of Showtime’s Providence, RI-set Brotherhood,”Uneasy Lies the Head”, written and directed by Henry Bromell, first aired 11/2/2008, a dentist is addicted to Oxycontin, and arrested by the DEA for distributing it, and other abused drugs, through fake prescriptions.
Medium - in the 4th season’s “Burn Baby Burn”, a two-parter by Javier Grillo-Marxuach and René Echevarria that concluded on NBC on 3/18/2008, a divorced dentist "Dr. Leo Krane" (played by Grant Shaud) not only heads a local foundation to provide medical care to the needy – he also drugs a young prostitute into undergoing dental work like the adulterous wife he’s having an affair with so when he sets the runaway on fire he can frame the husband for the wife’s murder, and the foundation, and the couple, can collect on the life insurance.
Life - “Mirror Ball” (on NBC, 2/11/2009, Season 2, Episode 14), by executive producer Rand Ravich, featured "the Rock 'n' Roll Dentist" "Dr. Stanton" (played by Patrick Fabian) in his Bel Air Dental Arts practice. He linked his nighttime gig in a metal covers band with his day job by talking in double entendres, and notches on his wall to represent sexual conquests of his grateful female patients, but really he was overwriting pain prescriptions, like almost all the dentists on TV shows.
Glenn Martin DDS on Nickelodeon beginning summer 2009 – an animated series about the dysfunctional family of an eccentric dentist. But he's on vacation, so his work seems only referred to be incidental as an interest. This isn't even the first time there's been an animated comedy series about a dentist. The 1998 – 2001 Canadian series Bob and Margaret aired in the U.S. on Comedy Central.
Bones had an unusually positive portrayal in "The Dentist in the Ditch" by Pat Charles and Josh Berman (Season 5, Episode #13, first broadcast on Fox on 1/28/2010), even if the dentist was the murder victim. The forensic technician makes a point of cleaning his skull's teeth: out of respect because he was a dentist. While he was a gay recreational football player who was being spitefully sued by his ex-hygienist, his murderer was his building contractor.
NCIS: In "Masquerade", by Steven D. Binder (Season 7, Episode #14, first broadcast on CBS , 2/2/2010) a dental office is used for something dangerous other than drugs on a TV show – to steal X-ray equipment that can be used to generate fuel for terrorists' dirty bombs. The dentist is tracked down as a potential collaborator from a social networking site for oral care providers. The movie-obsessed investigator is suspicious because Ever since "Marathon Man" I go for the dentist. They quickly determine that his supposed suicide is actually murder and he was not guilty.
Justified- "Long In The Tooth" by Chris Provenzano (Season 1, Episode 4, first broadcast on FX 4/6/2010) had a twist on the usual dental criminal in TV shows fit for a show anchored by an Elmore Leonard character: "Dr. Peter Oldham" (played by Alan Ruck) is really ex-cartel bag man "Roland 'Rollie' Pike" who used his ill-gotten gains when he fled the law and the outlaws to Panama to fulfill his childhood dream of becoming a dentist – inspired by the elf on the Rudolph, the Red-Nosed Reindeer TV special who wants to be dentist instead of a toy maker for Santa. Back in L.A., he would barter dental work for food, but he wasn't above repossessing inlays: You don't want to pay me? That's OK, but I'm going to take back what's mine! Consider me the repo man., earning him the nickname in the barrio as "The Crazy Dentist". He figures that if he can do that, he can kill a guy while escaping to Mexico with a coyote.
In the season finale of the first season of Glee, "Journey", written and directed by Brad Falchuk (first broadcast on Fox 6/8/2010) the virginal guidance counselor informs her ex that she's now dating someone else: [My dentist]'s always been impressed by my oral hygiene. . . and then he asked me out.
The Vampire Diaries - The CW introduced its Fall 2009 TV series by distributing promotional trinkets, and incidentally sexily promoting the use of dental floss. According to "Looking for Viewers. No Need to Pardon the Puns" by Stuart Elliott, The New York Times, 8/25/2009, the advertising campaign targeted at the young (plus me) CW audience was developed by Rick Haskins, executive vice president for marketing and brand strategy.
